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why would infant be cyanotic

amniotic fluid in lungcong. heart disease

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why would infant be cyanotic

amniotic fluid in lungcong. heart disease

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cong. heart vs respiratory cyanosis: how to tell the difference

listen for murmurs -single S2: worrisome

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baby PMI

right side hypertrophy, so right shifted-->just left of sternal border (vs. mid clavicular line in adults)-ensure not situs inversus-ensure no tension pneumothorax (R: right hyper expands, shift left of PMI, vis versa)

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baby PMI

right side hypertrophy, so right shifted-->just left of sternal border (vs. mid clavicular line in adults)

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cong. heart vs respiratory cyanosis: how to tell the difference

listen for murmurs -single S2: worrisome

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palpate this before listening to lungs/heart

PMI

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baby PMI

right side hypertrophy, so right shifted-->just left of sternal border (vs. mid clavicular line in adults)

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check pre-ductal (PDA) pulse ox

right arm: if lower no mixing??postductal : leg or left arm

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cardiac pre vs. post O2

pH: 7.44CO2: 20O2: 50

pH: 7.44CO2: 20O2: 54*not much change! problem with ductus, still not getting O2*

yes, can also intubate but use oxyhood if not as bad

what lung cells respond to surfactant

type 2 alveolar cells

can give exogenous surfactant?

complication of surfactant

pulmonary hemorrhage, calculate amount need to be given

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Sweat chloride test

The most discriminatory test for CF and is the gold standard-IRT/DNA method can detect single CFTR (cystic fibrosis transmembrane conductance regulator) gene(But child with single gene may not have CF)

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what lung cells respond to surfactant

type 2 alveolar cells

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meconium ileus

poor weight gain**(buzzword for CF)elevated IRT

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IRT: immunoreactive trypsinogen

Sweat chloride test

The most discriminatory test for CF and is the gold standard-IRT/DNA method can detect single CFTR (cystic fibrosis transmembrane conductance regulator) gene, i.e. + for carrier (But child with single gene may not have CF)>60 is dx40-60 intdeterminant (>30)-newborns don't sweat much

CF inheritance

autosomal recessivechromosome 7

CF affects

CF also affects

vas deferensnasal polyps

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In managing a child with CF, which of the following is the most appropriate choice? a. Pulmonary therapies including bronchodilators and mucolytics b. Macrolides for suspected bacterial infections c. Pancreatic enzymes only for those with pancreatitis d. Avoidance of live vaccines

give during cataharral stage, ameliorate, but after cough, have no effect on course but limit spread

CF tx

what dx studies for CF?

lymphocytes on CBC (70%), elevated WBC

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CF colonization

S aureus, nontypeable H influenzae, gram-negative bacilli P aeruginosa becomes predominant organism by 10 years of age.Antibiotic therapy continued for 2 to 3 weeks and may be given on an inpatient service combined with home IV therapy

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macrolide tx

give during cataharral stage, ameliorate, but after cough, have no effect on course but limit spread

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how to prevent pertussis

infant DTaPadult TdaPpregnant: TdaP + flu shot-->passive imm. to baby

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more wheezing bac or viral?

viral

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most common cause of bronchiolitis

RSV collect via saline tube on ice

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other causes of bronchiolitis

hMPV, adenovirus, influenza, hit kids

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peribronchial cuffing

"donut" rings around bronchi

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other CXR findings bronchiolitis

air expansion, air in subQ tissuses (crackly), hyperinflation

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bronchiolitis

don't need steroids, albuterol; but can trysev. may need to be intubated(premies, CV probe)

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RSV ppx

Palivizumab (MoAb IM) criteria: typ. premies on O2$$

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bronchiolitis: complications

Apnea (most common in premature infants and young term infants)PneumoniaAtelectasisDehydrationRespiratory failureBacterial superinfectionAir leaks